Surgical management of the frontal sinus

Changing the surgical dogma in frontal sinus trauma: transnasal endoscopic repair

“…Frontal sinus fractures are associated with high‐impact trauma and panfacial injuries as well as close proximity to intracranial and orbital structures, and their presence indicates a 42% risk of permanent neurologic compromise, 59% risk of orbital compromise, and up to a 25% mortality risk . In addition, fractures of the posterior table are commonly complicated by dural injury with pneumocephalus in 25% to 33%, CSF leak in 13% to 25%, and extradural hematoma in 10% of patients . With such high rates of associated trauma and sequelae, it is not surprising that management of such injuries is complex and influenced by many factors.…”

Frontal Sinus Fractures: Management and Complications

“…They concluded that successful obliteration of frontal sinus by either spontaneous osteoneogenesis or the implantation of autogenous fat, muscle, or bone depends on meticulous extirpation of the frontal sinus mucosa with the aid of an operating microscope, removal of the inner cortex of bone, and permanent occlusion of the nasofrontal duct 2021. Cranialization should be considered when the anatomic barrier between the sinus and intracranial cavity has been disrupted secondary to fractures of the posterior wall and dural tears 22. Cranialization involves removal of the entire posterior sinus wall and debridement of all sinus mucosa, followed by frontonasal duct blockade with pericranial flap and/or autogenous bone (Fig.…”

“…20,21 Cranialization should be considered when the anatomic barrier between the sinus and intracranial cavity has been disrupted secondary to fractures of the posterior wall and dural tears. 22 Cranialization involves removal of the entire posterior sinus wall and debridement of all sinus mucosa, followed by frontonasal duct blockade with pericranial flap and/or autogenous bone (►Fig. 5a-d).…”

Current practice in the management of frontal sinus fractures

“…1,2 Fractures involving both the anterior and posterior walls have been claimed to involve 0.7 per cent to 2.1 per cent of craniocerebral trauma. 3 The aetiology of these injuries is usually the result of high velocity impacts, road traffic accidents being the main mechanism followed by falls. 4 These high velocity impacts are usually associated with polytrauma and in this setting it is easy to understand the finding that these injuries are often overlooked.…”

“…Autogenous fat 33,34 and muscle 3,35 have been used, although McNeil 36 showed that while muscle was as effective as fat in obliteration, the fat remained viable while the muscle was replaced by fibrous tissue.…”